冷冻前胚胎因素对冻融胚胎移植结局的影响

Impact of pre-freeze embryo factors on clinical outcome in frozen-thawed embryo transfer cycles.

目的:探讨冻融胚胎移植周期中冷冻前胚胎因素对临床结局的影响。方法:回顾分析本生殖中心2009年1月～9月的589个冻融胚胎移植周期,根据冷冻前受精方式、胚胎培养时间、胚胎卵裂球数目、冷冻前≥6细胞胚胎个数分组。结果:589例冻融移植周期中共解冻胚胎2185枚,复苏率为69.5%,临床妊娠率26.5%。不同受精方式的临床妊娠率分别为23.4%,33.2%,差异有统计学意义;D2胚胎和D3胚胎冷冻后复苏率和临床妊娠率差异有统计学意义(71.4%vs69.1%和20.2%vs30.1%);冷冻前胚胎≥6细胞和<6细胞,两组的临床妊娠率(31.8%,22.0%)和卵裂球完全存活复苏率(23.7%,45.4%)比较,差异均有统计学意义;冷冻前3个及以上≥6细胞的胚胎复苏率最高为56.0%、卵裂球完全存活复苏率最低为20.9%,与冷冻前少于3个胚胎组相比差异有统计学意义。若冷冻前仅余1个≥6细胞胚胎,冷冻后复苏率显著高于仅余1个<6细胞胚胎,但卵裂球完全存活复苏率显著降低;和仅余2个胚胎相比,组间临床妊娠率无统计学差异。结论:冷冻前≥6细胞胚胎的妊娠结局优于<6细胞的胚胎;若冷冻前仅余1个<6细胞的胚胎,虽然冻融后复苏率较低,但仍有妊娠的可能,因此仍然建议冻存这部分胚胎,提高患者的累积妊娠率。

Objective：To analyze the pre-freeze embryo factors on post-thaw embryo clinical pregnancy rate in frozen-thawed embryo transfer（FET）.Methods：A retrospective analysis was performed on 589 FET cycles.Groups were divided according to the pre-freeze embryo source,pre-freeze embryonic culture time,embryo blastomere number and the number of exceeding 6 cell embryos.Results：A total of 2185 embryos were thawed in 589 transfer cycles,resulting in survival rate of 69.5% and clinical pregnancy rate of 26.5%.There was a significant difference in the pre-freeze embryo survival rates and clinical pregnancy rates between different embryo source.There was also a significant difference in survival rates and clinical pregnancy rates between D2 and D3 embryo.Pre-freeze embryo cell exceeded 6-cells comparing with less than 6,the clinical pregnancy rate（31.8%,22.0%） and total blastomere survival rate（23.7%,45.4%,respectively） were statistically significant.The survival rate was up to 56.0% in which had more than 3 pre-freeze embryo cell number exceeding 6-cell,and total blastomere survival rate was 20.9%,the differences were statistically significant comparing to those with less than 3 pre-freeze embryo.If before frozen remaining a more than 6-cell embryo,the survival rate was significantly higher than remaining a less than 6-cell embryo,but total blastomere survival rate was significantly reduced,the clinical pregnancy rate between the two groups showed no statistical difference.Conclusion：Pre-freeze embrys with more than 6-cells have higher pregnancy rate,the outcome is better than less than 6-cells embryo.If remaining a less than 6-cell embryo before frozen,although after thawed with low survival rate,there is still the possibility of pregnancy,so it is recommended that we can froze this part of the embryos to improve accumulated pregnancy rate.